Healthcare Finance Staff
Federal healthcare auditors think Medicaid managed care organizations aren't doing enough to combat fraud and that states might have to step in with policy changes.
Through the beginning of March, 4.2 million Americans signed up for private coverage through state and federally-run exchanges, leaving federal health officials hoping for a final month's surge to meet initial projections, especially for millennials.
Aetna is going forward with an accountable care agreement for some 28,000 people, partnering with a health system that also has accountable care contracts with some competitors.
WellPoint's Amerigroup is the first Medicaid plan in the nation to use a health record chip that enthusiasts are calling a "breakthrough health IT solution."
The National Committee for Quality Assurance wants to modernize its health plan accreditation program with a range of new requirements that in some cases mirror trends in regulatory scrutiny.
Under pressure from the industry and Congress, the Centers for Medicare & Medicaid Services is withdrawing several proposed changes to the Medicare drug program, but still charging ahead with others that could prove disruptive.
After a one year delay, the federal government is giving states a framework to create insurance programs for low-income residents earning above the Medicaid eligibility threshold, potentially encouraging more experimentation with public payer policies.
While many states have been challenged to expand their insured populations in ways encouraged by the Affordable Care Act, Ohio and Kentucky have leveraged their distinctive political and business climates to find early success.
Humana is naming a healthcare outsider as its next chief innovation officer, just as executives are looking for breakthroughs from recent acquisitions.
The Centers for Medicare & Medicaid Services' proposal to mandate broader provider networks in public insurance exchanges could have the unintended consequence of discouraging insurer participation, according to analysts at Moody's.